Forum.
Role of other professional carers and consultants
We do not know the degree of involvement of non-physician carers in decisions regarding sedation for intractable symptoms, and the role of nursing may be under-represented in the literature, despite the fact that nurses are integrally involved in initiating and managing sedation (Woods, Tansjo). In a philosophical essay on the role of nursing in sedation, Woods (2004 & 2004) states that nurses have an important role to play in decision-making. Morita et al [Pall Med 2004] reported that some nurses experienced an emotional burden when caring for sedated patients, especially when their perspectives were not considered. In a recent survey that included questions about the decision-making process for sedation, two thirds of Japanese physicians reported that in 75 % of cases they “obtained permission” from the nurses as well as the patient and family (Morita SCC Feb 2004).
Werth (2004) asserts that the value of consultation is not to be underestimated when end-of-life decisions are being made. Some authors recommend consulting experts to either assist in determining intractability or to assist with the decision-making process that leads to the use of sedation for intractable symptoms, especially when the indication is existential distress (2,3,25; Barreth; Lanuke). In an era of near-instant communication, multidisciplinary colleagues worldwide can be and are consulted via telephone, e-mail and electronic discussion groups.
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